体外与非体外循环冠状动脉旁路移植术后移植血管通畅率的比较  

Comparison of Graft Patency between On-pump and Off-pump Coronary Artery Bypass Grafting

作　　者：刘畅[1] 刘宗泓[1] 肖喜刚[2] 朱凯[2] 马丽园[1] 于辉[1] 徐磊[1] 刘宏宇[1] 

机构地区：[1]哈尔滨医科大学附属第一医院心血管外科,哈尔滨150001 [2]哈尔滨医科大学附属第一医院CT影像科,哈尔滨150001

出　　处：《中国胸心血管外科临床杂志》2013年第3期289-293,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：黑龙江省青年科学基金资助项目(QC2012C093)~~

摘　　要：目的比较常规体外循环冠状动脉旁路移植术(CCABG)与非体外循环冠状动脉旁路移植术(OPCAB)患者术后2周、3个月和1年的桥血管通畅率。方法回顾性分析2010年5月至2011年11月哈尔滨医科大学附属第一医院200例行冠状动脉旁路移植术(CABG)患者的临床资料。将200例患者按手术方式不同分为两组,CCABG组:61例,男32例,女29例;年龄(59.8±4.7)岁;OPCAB组:139例,男72例,女67例;年龄(59.6±8.9)岁。分别于术后2周、3个月及1年行256排多层螺旋CT冠状动脉造影(256-MSCTA)检查,比较两种手术方式桥血管的通畅性。结果术后2周、3个月及1年,乳内动脉桥、大隐静脉桥通畅率CCABG组与OPCAB组比较(术后1年乳内动脉桥通畅率:92.31%vs.91.94%;术后1年大隐静脉桥通畅率:91.35%vs.90.00%)差异无统计学意义(P>0.05);按照远端吻合口位置比较,吻合口位于左前降支的桥血管通畅率大于右冠状动脉,差异有统计学意义(术后1年97.78%vs.85.90%,P<0.05),但OPCAB组与CCABG组比较差异无统计学意义(P>0.05)。手术近期疗效比较:呼吸机辅助呼吸时间、ICU监护时间、24 h纵隔引流量、24 h输血量、住院时间和住院费用等指标OPCAB组优于CCABG组(P<0.05)。结论 CCABG与OPCAB术后近期桥血管通畅率相似,吻合口位于左前降支的桥血管通畅率较高,OPCAB在围术期疗效上显示出明显的优势。Objective To compare the graft patency rates of conventional on-pump coronary artery bypass grafting （CCABG） and off-pump coronary artery bypass grafting （OPCAB） at 2 weeks, 3 months and 1 year after surgery. Methods Clinical data of 200 patients who underwent coronary artery bypass grafting （CABG） in the First Affiliated Hospital of Harbin Medical University from May 2010 to November 2011 were retrospectively analyzed. All the 200 patients were divided into two groups according to different surgical procedures they received： CCABG group, 61 patients including 32 male patients and 29 female patients with their age of 59.8±4.7 years; and OPCAB group, 139 patients including 72 male patients and 67 female patients with their age of 59.6 ±8.9 years. Graft patency of all the patients was evaluated by 256-slice multislice computed tomography angiography （256-MSCTA） at 2 weeks, 3 months and 1 year after CABG and compared between two groups. Results At 2 weeks, 3 months and 1 year after CABG, the graft patency rates of left internal mammary artery （LIMA） grafting were not statistically different between CCABG group and OPCAB group, as well as those of great saphenous vein （GSV） grafting （P 〉 0.05 ）, The 1 year graft pateney rates of LIMA grafting of CCABG group and OPCAB group were 92.31% and 91.94% respectively, and 1 year graft patency rates of GSV grafting of CCABG group and OPCABgroup were 91.35% and 90.00% respectively. To compare the graft patency rates of different distal anastomotic locations, grafting to the left anterior descending （LAD） coronary artery had significantly higher patency rate than grafting to the right coronary artery （RCA, P 〈 0.05）. The 1 year graft patency rates of LAD grafting and RCA grafting were 97.78% and 85.90% respectively. But there was no statistical difference in graft patency rates at different respective distal anastomotic locations between OPCAB group and CCABG group （P 〉 0.05）. To compare early clinical outcomes of two groups, pos

关 键 词：冠状动脉旁路移植术 移植血管 通畅率 体外循环 

分 类 号：R654.2[医药卫生—外科学]